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Dadiz R, Bender J, Robin B. Simulation-based operations testing in new neonatal healthcare environments. Semin Perinatol 2023; 47:151828. [PMID: 37775365 DOI: 10.1016/j.semperi.2023.151828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
In situ simulations, those conducted in the actual clinical environment, confer a high level of contextual fidelity and have been applied to the operations testing of new healthcare environments (HCE) to identify potential threats to patient, family and staff safety. By conducting simulation-based operations testing, these latent safety threats (LSTs) - which are weaknesses in communications, human factors, system process and technologies, and the way they are linked together - can be identified and corrected prior to moving patients into the new HCE. Simulation-based operations testing has extended to the neonatal HCE, as neonatal intensive care units (NICUs) transition from open-bay to single-family room design. In this section, we define LSTs, review simulation-based operations testing in new neonatal and perinatal HCEs, review challenges associated with conducting simulation-based operations testing, and briefly review pre-construction simulation-based user-centered design of new HCEs.
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Affiliation(s)
- Rita Dadiz
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jesse Bender
- Department of Pediatrics, Virginia Tech Carillon School of Medicine, Roanoke, VA, USA
| | - Beverley Robin
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA
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2
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Zhang C. A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4487. [PMID: 36901496 PMCID: PMC10002261 DOI: 10.3390/ijerph20054487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.
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Affiliation(s)
- Cevin Zhang
- School of Media and Design, Beijing Technology and Business University, Sunlight South Road 1, Beijing 102488, China
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Kennedy C, Sycip M, Woods S, Ell L. A Novel Approach to Emergency Department Readiness for Airborne Precautions Using Simulation-Based Clinical Systems Testing. Ann Emerg Med 2023; 81:126-139. [PMID: 36257865 PMCID: PMC9568412 DOI: 10.1016/j.annemergmed.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVES Emergency department (ED) COVID-19 preparations required rethinking workflows and introducing the potential for errors. Simulation provides a nimble methodology integrating into situ training and systems testing to prepare staff, detect potential workflow latent safety threats and provide recommendations for mitigation. METHODS We developed 5 onsite rapid-cycle ED simulation cases using "tipping points" related to new protocols coupled with a structured observation tool. Staff observed simulations, recorded adherence to protocols, identified safety threats, discussed mitigation strategies, and participants completed an evaluation using a 5-point Likert scale. Latent safety threats were prioritized by risk and escalated to leadership. RESULTS Through 44 simulations, 76 staff identified 31 unique latent safety threats in the following categories: job aids 9 (29%), isolation measures 8 (26%), communication and personnel 6 (19%), and technology and equipment 8 (26%). Eleven high-priority safety threats were escalated to ED leadership. Sixty-five staff (86% of participants) completed a web-based evaluation reporting that simulations were worth the time (86% strongly agreed), an effective way to test the system (92% strongly agreed), and an acceptable way to improve (92% strongly agreed). CONCLUSION Our study demonstrated that simulation-based clinical systems test methods are adaptable for rapid preparedness evaluation and training. In combination with rapid-cycle deliberate practice, many latent safety threats were identified prior to clinical implementation. Our work highlights a novel application of simulation systems to increase system preparedness and reduce the potential for errors which may be applicable in diverse settings for designing, evaluating, and training staff in new protocols and procedures.
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Affiliation(s)
- Christopher Kennedy
- Division of Emergency Medicine, Center for Pediatric Simulation and Resuscitation, Children’s Mercy Hospital Kansas City, Kansas City, MO,Corresponding Author
| | - Marc Sycip
- Division of Emergency Medicine, Center for Pediatric Simulation and Resuscitation, Children’s Mercy Hospital Kansas City, Kansas City, MO
| | - Shautonja Woods
- Department of Quality and Safety, Center for Pediatric Simulation and Resuscitation, Children’s Mercy Hospital Kansas City, Kansas City, MO
| | - Lisa Ell
- Department of Quality and Safety, Center for Pediatric Simulation and Resuscitation, Children’s Mercy Hospital Kansas City, Kansas City, MO
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4
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Truchot J, Boucher V, Li W, Martel G, Jouhair E, Raymond-Dufresne É, Petrosoniak A, Emond M. Is in situ simulation in emergency medicine safe? A scoping review. BMJ Open 2022; 12:e059442. [PMID: 36219737 PMCID: PMC9301797 DOI: 10.1136/bmjopen-2021-059442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To provide an overview of the available evidence regarding the safety of in situ simulation (ISS) in the emergency department (ED). DESIGN Scoping review. METHODS Original articles published before March 2021 were included if they investigated the use of ISS in the field of emergency medicine. INFORMATION SOURCES MEDLINE, EMBASE, Cochrane and Web of Science. RESULTS A total of 4077 records were identified by our search strategy and 2476 abstracts were screened. One hundred and thirty full articles were reviewed and 81 full articles were included. Only 33 studies (40%) assessed safety-related issues, among which 11 chose a safety-related primary outcome. Latent safety threats (LSTs) assessment was conducted in 24 studies (30%) and the cancellation rate was described in 9 studies (11%). The possible negative impact of ISS on real ED patients was assessed in two studies (2.5%), through a questionnaire and not through patient outcomes. CONCLUSION Most studies use ISS for systems-based or education-based applications. Patient safety during ISS is often evaluated in the context of identifying or mitigating LSTs and rarely on the potential impact and risks to patients simultaneously receiving care in the ED. Our scoping review identified knowledge gaps related to the safe conduct of ISS in the ED, which may warrant further investigation.
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Affiliation(s)
- Jennifer Truchot
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Emergency Department, CHU Cochin- Université de Paris, APHP, Paris, France
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Valérie Boucher
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Quebec, Canada
| | - Winny Li
- 5Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Guillaume Martel
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
| | - Eva Jouhair
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Éliane Raymond-Dufresne
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Andrew Petrosoniak
- 5Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marcel Emond
- Département de médecine familiale et de médecine d'urgence, Université Laval Faculté de médecine, Quebec, Quebec, Canada
- Emergency Department, CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Quebec, Canada
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Holmes J, Chipman M, Barbour T, DiLisio C, Morejon O, Graydon-Baker E, Mallory L. A Simulation Systems Testing Program Using HFMEA Methodology Can Effectively Identify and Mitigate Latent Safety Threats for a New On-Site Helipad. Jt Comm J Qual Patient Saf 2021; 48:12-24. [PMID: 34782292 DOI: 10.1016/j.jcjq.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fundamental changes in critical systems within hospitals present safety risks. Some threats can be identified prospectively, others are only uncovered when the system goes live. Simulation and Healthcare Failure Mode and Effect Analysis (HFMEA) can be used together to prospectively test a system without endangering patients. The research team combined iterative simulations and HFMEA methodologies to conduct simulation-based clinical systems testing (SbCST) to detect and mitigate latent safety threats (LSTs) prior to opening a hospital helipad. METHODS This study was conducted in three phases. In Phase I, an interprofessional team created a process map and conducted a tabletop exercise, identifying LSTs that could theoretically occur during patient transfer from the new helipad. Using HFMEA methodology, steps predicted to be affected by the new helipad were probed. Identified LSTs were assigned a hazard score. Mitigation solutions were proposed. Results from Phase I were used to plan Phase II, which used low-fidelity simulation to test communication processes and travel paths. High-fidelity simulation was used in Phase III to test previously identified LSTs. RESULTS Over three testing phases, 31 LSTs were identified: 15 in Phase I, 7 in Phase II, and 9 in Phase III. LSTs fell under the categories of care coordination, facilities, and equipment, and devices. Eighteen (58.1%) were designated "critical" (hazard score ≥ 8). CONCLUSION A three-phase SbCST program using HFMEA methodology was an effective tool to identify LSTs. An iterative approach, using results of each phase to inform the structure of the next, facilitated testing of proposed mitigation strategies.
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Abulebda K, Thomas A, Whitfill T, Montgomery EE, Auerbach MA. Simulation Training for Community Emergency Preparedness. Pediatr Ann 2021; 50:e19-e24. [PMID: 33450035 DOI: 10.3928/19382359-20201212-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Most infants and children who are ill and injured are cared for in community-based settings across the emergency continuum. These settings are often less prepared for pediatric patients than dedicated pediatric settings such as academic medical centers. Disparities in health outcomes exist and are associated with gaps in community emergency preparedness. Simulation is an effective technique to enhance emergency preparedness to ensure the highest quality of care is provided to all pediatric patients. In this article, we summarize the pediatric emergency care provided across the emergency continuum and outline the key features of simulation used to measure and improve pediatric preparedness in community settings. First, we discuss the use of simulation as a training tool and as an investigative methodology to enhance emergency preparedness across the continuum. Next, we present two examples of successful simulation-based programs that have led to improved emergency preparedness. [Pediatr Ann. 2021;50(1):e19-e24.].
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Gable B, Duncan M. Use of simulation to improve fire department standard operating procedure for bariatric patient extrication. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 6:123-124. [DOI: 10.1136/bmjstel-2018-000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2019] [Indexed: 11/04/2022]
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Kaba A, Barnes S. Commissioning simulations to test new healthcare facilities: a proactive and innovative approach to healthcare system safety. Adv Simul (Lond) 2019; 4:17. [PMID: 31346476 PMCID: PMC6636135 DOI: 10.1186/s41077-019-0107-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/25/2019] [Indexed: 12/22/2022] Open
Abstract
Development and reconstruction of new healthcare facilities and spaces has the potential for latent safety threats to emerge, specifically unintentional harm that could affect actual patients once the facility opens, such as missing equipment, inefficient setup, or insufficient space for procedures. Process-orientated simulation and testing is a novel innovation in healthcare. The aim of process-orientated simulations and debriefing is to examine the process of care, rather than the outcome of care. These simulations, which take place in actual patient care settings and environments prior to occupancy, are an emerging strategy that can be used to test new environments and new healthcare facilities to ensure that the spaces created match the needs of the staff and administration, while proactively identifying latent safety threats prior to delivering patient care. In turn, these simulations can be also be used as part of the new site orientation and training plan. The aim of this paper is to examine a case study describing the use of the novel innovation of process-orientated simulations to test the opening of a new 300-bed healthcare facility.
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Affiliation(s)
- Alyshah Kaba
- eSIM Provincial Program, Alberta Health Services, South Tower Foothills Hospital, 1403 29 St. NW, Calgary, T2N 2T9 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB T2N 2 T9 Canada
| | - Sue Barnes
- South eSIM Provincial Simulation Program, Alberta Health Services, South Health Campus, 4448 Front Street SE, Calgary, T3M 1 M4 Canada
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Teo SSS, Oakley E, Stanford J, Cichero J. Paediatric acute care: Highlights from the Paediatric Acute Care-Advanced Paediatric Life Support Conference, Hobart, 2018. Emerg Med Australas 2019; 31:676-679. [PMID: 30916465 DOI: 10.1111/1742-6723.13285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 11/30/2022]
Abstract
The Paediatric Acute Care Conference (PACC) is an annual conference organised by APLS Australia to advance paediatric acute care topics for clinicians in pre-hospital medicine, EDs, acute paediatrics, intensive care and anaesthesia. The PACC 2018 was held in Hobart, Tasmania. We provide a summary of some of the presentations.
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Affiliation(s)
- Stephen Sze Shing Teo
- Paediatric and Emergency Departments, Blacktown and Mt Druitt Hospitals, Sydney, New South Wales, Australia.,Paediatric Department, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Ed Oakley
- Department of Emergency Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Paediatric Research in Emergency Departments International Collaborative, Melbourne, Victoria, Australia
| | - Jane Stanford
- Advanced Paediatric Life Support Australia, Melbourne, Victoria, Australia
| | - Jane Cichero
- Emergency Services, Sydney Children's Hospital, Sydney, New South Wales, Australia
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Lim WS, Meakin G, Brittain C, Bewick T, Duley L. Improving readiness for recruitment through simulated trial activation: the Adjuvant Steroids in Adults with Pandemic influenza (ASAP) trial. Trials 2017; 18:546. [PMID: 29145878 PMCID: PMC5693476 DOI: 10.1186/s13063-017-2290-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/16/2017] [Indexed: 11/21/2022] Open
Abstract
Background Research in public health emergencies requires trials to be set up in readiness for activation at short notice and in anticipation of limited timelines for patient recruitment. We conducted a simulated activation of a hibernating pandemic influenza clinical trial in order to test trial processes and to determine the value of such simulation in maintaining trial readiness. Methods The simulation involved the Nottingham Clinical Trials Unit, one participating hospital, one manufacturing unit and the Investigational Medicinal Product (IMP) supplier. During the exercise, from 15 September 2015 to 2 December 2015, clinical staff at the participating site completed the trial training package, a volunteer acting as a patient was recruited to the study, ‘dummy’ IMP was prescribed and follow-up completed. Results Successful activation of the hibernating trial with patient recruitment within 4 weeks of ‘arousal’ as planned was demonstrated. A need for greater resilience in anticipation of staff absenteeism was identified, particularly in relation to key trial procedures where the potential for delay is high. A specific issue relating to the IMP Stock Control System was highlighted as a potential source of error that could compromise the randomisation sequence. The simulation exercise was well received by site investigators and increased their confidence in being able to meet the likely demands of the trial when activated. The estimated cost of the exercise was £1995; 90% of this being staff costs. Conclusions Simulated activation is useful as a means to test, and prepare for, the rapid activation of ‘hibernating’ research studies. Whether simulation exercises can also help reduce waste in complex clinical trial research deserves further exploration. Trial registration EudraCT Number 2013-001051-12, ISRCTN72331452. Registered on 6 March 2013.
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Affiliation(s)
- Wei Shen Lim
- Respiratory Medicine, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, NG5 1 PB, England, UK.
| | - Garry Meakin
- Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, England, UK
| | - Clare Brittain
- Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, England, UK
| | - Thomas Bewick
- Respiratory Medicine, Derby Teaching Hospitals NHS Foundation Trust, Uttoxeter Rd, Derby, DE22 3NE, England, UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, England, UK
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Barlow M, Dickie R, Morse C, Bonney D, Simon R. Documentation framework for healthcare simulation quality improvement activities. Adv Simul (Lond) 2017; 2:19. [PMID: 29450020 PMCID: PMC5806278 DOI: 10.1186/s41077-017-0053-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 10/11/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Robyn Dickie
- Mater Education Ltd, Queenslane, Brisbane, Australia
| | - Catherine Morse
- Center for Medical Simulation, Queenslane, Brisbane, Australia
| | - Donna Bonney
- Mater Education Ltd, Queenslane, Brisbane, Australia
| | - Robert Simon
- Center for Medical Simulation, Queenslane, Brisbane, Australia
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12
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Gardner AK, Johnston M, Korndorffer JR, Haque I, Paige JT. Using Simulation to Improve Systems-Based Practices. Jt Comm J Qual Patient Saf 2017; 43:484-491. [PMID: 28844234 DOI: 10.1016/j.jcjq.2017.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ensuring the safe, effective management of patients requires efficient processes of care within a smoothly operating system in which highly reliable teams of talented, skilled health care providers are able to use the vast array of high-technology resources and intensive care techniques available. Simulation can play a unique role in exploring and improving the complex perioperative system by proactively identifying latent safety threats and mitigating their damage to ensure that all those who work in this critical health care environment can provide optimal levels of patient care. METHODS A panel of five experts from a wide range of institutions was brought together to discuss the added value of simulation-based training for improving systems-based aspects of the perioperative service line. Panelists shared the way in which simulation was demonstrated at their institutions. The themes discussed by each panel member were delineated into four avenues through which simulation-based techniques have been used. RESULTS Simulation-based techniques are being used in (1) testing new clinical workspaces and facilities before they open to identify potential latent conditions; (2) practicing how to identify the deteriorating patient and escalate care in an effective manner; (3) performing prospective root cause analyses to address system weaknesses leading to sentinel events; and (4) evaluating the efficiency and effectiveness of the electronic health record in the perioperative setting. CONCLUSION This focused review of simulation-based interventions to test and improve components of the perioperative microsystem, which includes literature that has emerged since the panel's presentation, highlights the broad-based utility of simulation-based technologies in health care.
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